Kamata Masahiro, Tada Yayoi
Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
JID Innov. 2023 Feb 24;3(3):100195. doi: 10.1016/j.xjidi.2023.100195. eCollection 2023 May.
Recently, Jak inhibitors such as baricitinib, upadacitinib, and abrocitinib were approved for the treatment of atopic dermatitis (AD) in addition to biologics, including dupilumab, tralokinumab, and nemolizumab. The increase in treatment options can be a benefit to patients with AD. Meanwhile, it could make it difficult for physicians to choose the best treatment among those treatment options. Biologics and Jak inhibitors differ in efficacy, safety, route of administration, and whether or not there is a concern about immunogenicity in addition to the evidence on comorbidities. Among the three Jak inhibitors, the degree of inhibition of signal transducer and activator of transcription differs in each Jak inhibitor. Therefore, the efficacy and safety profiles of the three Jak inhibitors are different. Physicians who treat patients with AD with Jak inhibitors and biologics need to understand the current evidence and choose the best treatment for individual patients. In this review, we discuss how integrating knowledge of the mechanisms of action of Jak inhibitors and biologics, the potential significant adverse events of these drugs, and the age and comorbidities of the patient can help achieve optimal clinical benefit for patients with moderate-to-severe AD refractory to topical agents.
最近，巴瑞替尼、乌帕替尼和阿布昔替尼等JAK抑制剂除了被批准用于治疗特应性皮炎（AD）的生物制剂（包括度普利尤单抗、曲罗芦单抗和奈莫利单抗）外，也被批准用于治疗特应性皮炎。治疗选择的增加对AD患者可能是有益的。与此同时，这可能会使医生难以在这些治疗选择中挑选出最佳治疗方案。生物制剂和JAK抑制剂在疗效、安全性、给药途径、是否存在免疫原性问题以及共病证据方面存在差异。在这三种JAK抑制剂中，每种JAK抑制剂对信号转导和转录激活因子的抑制程度各不相同。因此，这三种JAK抑制剂的疗效和安全性概况也有所不同。使用JAK抑制剂和生物制剂治疗AD患者的医生需要了解当前的证据，并为个体患者选择最佳治疗方案。在这篇综述中，我们讨论了如何整合JAK抑制剂和生物制剂的作用机制知识、这些药物潜在的重大不良事件以及患者的年龄和共病情况，有助于为外用药物难治的中度至重度AD患者实现最佳临床效益。
